What is Food Oral Immunotherapy (Food OIT)?
Food OIT is the administration of small, gradually increasing doses of the specific food that you/your child are allergic to, with the aim to increase the amount of food (threshold) that you can tolerate.
This process is called
‘DESENSITIZATION’.
Frequently Asked Questions
What is the difference between ‘desensitization’ and ‘long-term tolerance’?
‘Desensitization’ refers to an increase in the amount of allergen/food you can eat before reacting and requires ongoing (daily) dose ingestion.
‘Long term tolerance’ means you can eat any amount of food and have breaks from eating the food for periods of time, without any problems or the need for ongoing treatment (daily dosing).
We know, from research studies that food OIT results in desensitization in the majority of people, but NOT long-term tolerance. Currently there is little evidence on long term tolerance with OIT, but studies are still ongoing in that area.
What does the process involve and how often do I have to come into hospital?
Food OIT requires a significant time commitment and multiple hospital visits.
Specifically, for Peanut: OIT with Palforzia will involve an initial visit for assessment (to ensure it is safe to undergo treatment with the drug), a visit for rapid initial dose escalation and a minimum of 11 up-dosing visits (for regular dose increases) approximately every 2 weeks.
What is the goal of food OIT?
The goal is to reach a daily dose which will protect you against accidental exposure. Over time (usually months) of continued (daily) treatment, most patients (not all) will be able to tolerate larger amounts of the allergenic food. The daily maintenance dose must be ingested in order to maintain desensitization.
How are the doses given?
The doses are given orally.
Specifically, for Peanut: Palforzia consists of capsules containing peanut powder. The capsules will be opened and the peanut powder will need to be mixed with semisolid food (e.g. apple sauce, yoghurt). Your allergist will advise on each dose you will need to take.
What are the main benefits of food OIT?
What are the main risks?
Food oral immunotherapy may cause allergic symptoms including sneezing, runny nose, hives and angioedema (swelling below the surface of the skin), flushing, flares of eczema, itching of the eyes, nose, mouth or throat, nausea, vomiting, stomach discomfort or pain, cramping, cough, wheezing, and/or shortness of breath.
The majority of these reactions are mild/moderate in severity, but severe allergic reactions called ‘anaphylaxis’ have also been reported with OIT. Anaphylaxis involves combinations of the allergic symptoms listed above and can range from mild to severe. It is immediately treated with Epinephrine and any additional medication, as appropriate for each reaction. Allergic reactions due to food OIT may occur right after dosing or may be delayed; can also occur unexpectedly, with a dose that has previously been tolerated and are often associated with co-factors such as infection, exercise, menstruation and sleep deprivation.
All patients undertaking treatment with Palforzia for peanut OIT will need to be enrolled in the Palforzia Risk Evaluation and Mitigation Strategy (REMS) Program.
Do I still need to carry all emergency medication?
It is crucial that emergency medication is ALWAYS available with you/your child as reactions can be unexpected during food OIT.
All patients undertaking treatment with Palforzia for peanut OIT.
How do I know if I am eligible for this treatment?
The Texas Allergy, Asthma and Immunology Society (TAAIS) is a group of more than 220 board-certified Allergists/Immunologists in Texas.
An Allergist/Immunologist is a physician, usually an Internist or Pediatrician, who has had special training and experience in the field of Allergy and Immunology and who is considered to be an expert in the diagnosis and management of immune system disorders such as asthma, allergic rhinitis (hay fever), eczema, urticaria (hives), drug reactions, food allergies, immune deficiencies, and all general aspects of anaphylaxis.
A Board Certified Allergist/Immunologist is a physician who has passed the certifying examination of the American Board of Allergy and Immunology. A list of Board Certified Allergists can be found here. Those with “ABAI” under Board Certification are Board Certified Allergists/Immunologist.
Written by: Dr. Aikaterini Anagnostou
Associate Professor of Pediatric Allergy
Director, Food Immunotherapy Program
Co-Director, Food Allergy Program
Baylor College of Medicine
Texas Children’s Hospital